Sometimes when patients are admitted to the hospital, they can get infections. These are called health care-associated infections.

What is a Ventilator Associated Pneumonia (VAP)?

For our public reporting purposes, ventilator associated pneumonia (VAP) is defined as a pneumonia (lung infection) occurring in patients in an intensive care unit (ICU) requiring external mechanical breathing support (a ventilator) intermittently or continuously, through a breathing tube for more than 48 hours.

VAP can develop in patients for many reasons. Because they are relying on an external machine to breath, their normal coughing, yawning, and deep breath reflexes are suppressed. Furthermore, they may have a depressed immune system, making them more vulnerable to infection.

ICU teams have many ways to try to assist patients with these normal breathing reflexes, but despite this, patients are still at risk for developing pneumonia.

What determines the rate?

All hospitals with ICUs required to report into the Critical Care Information System (CCIS) — a centralized data collection system where hospitals report a variety of critical care information — must publicly report the VAP indicator data. This includes North York General Hospital.

Hospitals are posting their quarterly VAP rate and case count for those infections acquired in their facility, using the following formula:

total # of ICU cases of VAP after 48 hours of mechanical ventilation X 1000
total # of ventilator days for ICU patients 18 years and older

What are the signs and symptoms of VAP?

The most important symptoms include:

Fever

Low body temperature

New purulent sputum (foul smelling infectious mucous or phlegm coughed up from the lungs or airway into the mouth)

Hypoxia (decreasing amounts of oxygen in the blood).

What are the risk factors for VAP?

Risk factors include:

Being on a ventilator for more than five days

Recent hospitalization (last 90 days)

Residence in a nursing home

Prior antibiotic use (last 90 days)

Dialysis treatment in a clinic

If VAP is suspected, diagnostic investigations are made to determine the type of bacteria and the patient may be started on a broad-spectrum antibiotic. Once the specific bacteria are identified, a different antibiotic may be started and continued until the patient's symptoms resolve (usually in about seven to 14 days).

What do we do to control VAP?

The goal in controlling VAP is prevention through a variety of strategies designed to reduce the amount of exposure to the patient. Together, these strategies make up the "Ventilator Bundle,"or "vent bundle" as it is commonly known, and are reviewed for each patient who has an endotracheal tube (ETT) or tracheostomy tube every single day.

The "vent bundle" is made up of five elements that are designed to provide comprehensive care to the ventilated patient. One very important element of the bundle is to raise the head of the patient's bed up to at least 30 degrees. It is also essential for the patient's health care team (physicians, nurses, dieticians) to discuss every day whether the patient still requires the ETT or tracheostomy.

Other elements of the vent bundle include using medication to prevent blood clots in large veins and stomach ulcers and the use of oral versus nasal tubes for access to the trachea or stomach.

The critical care unit at North York General Hospital treats many patients who require mechanical ventilation, and by strictly adhering to the vent bundle, we can help prevent and control the incidence of VAP.

What can patients do to help reduce their chances of infection?

Frequent hand cleaning is a good way to prevent the spread of infection. Hand hygiene involves everyone in the hospital, including patients.